AAOM President's Report

By William Morris, DAOM, PhD, LAc

The American Association of Oriental Medicine (AAOM) was formed in 1981 to be the unifying force for American acupuncturists who are dedicated to high educational standards and the well-regulated ethical practice of acupuncture and Oriental medicine.

The AAOM's mission is to promote excellence and integrity in the professional practice of acupuncture and Oriental medicine. Overall, the public perception of the AAOM is becoming increasingly positive.

Conference Committee

The AAOM conference in Chicago this October promises to be great. Deborah Lincoln's leadership of the conference committee has led to the timeliest preparation for a conference in AAOM history. With assistance at the local level from past president Claudette Baker, the preparations for the conference are energized. Recognition goes to past president Gene Bruno for edits, presence and tempered consideration of process. Rebekah Christensen has enhanced AAOM's administrative processes by creating online interactive documentation for exhibition materials to include our abstract submission via AAOM's call for papers, as well as vendor and attendee online registration. This promises to be one of our best conferences ever. I believe it will be a milestone of return from the split of the field that occurred in Chicago in 1994. Lastly, the AAOM remains committed to collaboration with other national associations in order to ensure satisfaction with the choice of conference venues.

New OB/GYN Language

The AAOM and the American Acupuncture Council (AAC) announced the first move to expand malpractice insurance coverage in 20 years at a public meeting during the California State Oriental Medical Association's conference in April. The language changes were conducted via a 12-person national task force composed of representatives from each region. Two question-and-answer consensus documents were produced by the task force addressing language.

On Saturday, Apr. 30 at the CSOMA conference, Gene Bruno and Mike Schroeder presented to a public forum the new proposed language for obstetrics and gynecology that would be included in AAC's malpractice policies. It was explained to the forum participants that the AAOM went to AAC to have more definitive language included in their malpractice policies, and that AAC was openly receptive to working with the profession to achieve this goal. It was further explained to the forum that the language was developed through a process that included initial draft language developed by AAOM and AAC and refined by practitioners who participated in a national task force facilitated by the AAOM. This draft language was then submitted to state associations and AAOM members for feedback. The CSOMA conference public forum was the last step in the process, and the language will now be submitted to the underwriting insurance companies for final approval and inclusion in policies. When completed, this will be the first major change in language for malpractice policies in 20 years. As an ongoing project, AAOM and AAC will continue to work together to present additional definitive language to insurers for inclusion in policies.

American Psychological Association

The APA has contacted us regarding the Practice Guidelines for the Treatment of Patients With Substance Use Disorders, 2nd edition. The association is asking for comment on the recommendations in the guidelines. An example of the document's conclusions follows:

"Acupuncture is a somatic treatment that has been used frequently in the treatment of patients with substance use disorders. Two recent large randomized controlled trials (Bullock et al. 1999; Margolin et al. 2002) of auricular acupuncture (which is supposed to be specifically helpful for patients with substance use disorders) found acupuncture to be no more effective than relaxation techniques or needle insertion/sham acupuncture control. Thus, auricular acupuncture cannot be recommended as a sole treatment for cocaine dependence."

In my search for expert opinion on this matter, I contacted Michael Smith (the grandfather of acupuncture detoxification) in New York. He was affable and helpful. He was amazed that the APA contacted us rather than the medical acupuncturists, and suggested that we cultivate this relationship. His recommendation was to recognize them for consulting professional acupuncturists. He also suggested that we not attack the studies, since they are already aware of the general weakness of studies for any intervention in the area of substance abuse.

At this stage we will recommend that the APA comment in the Guidelines about the usage patterns for acupuncture detoxification in the some 1,000 clinics here in North America as well as the remarkable breakthroughs in England for acupuncture detox. The fact that the APA is consulting with the AAOM on the development of this publication is significant. I have included the studies that are cited in the recommendations below.

Herb importation and access: Ma huang will likely continue to be restricted at the border, despite the release of a manufacturer's bulk ma huang from the FDA. There is concern that a new category for herbs will not be inadvertently created as hoped but that Asian herbs will now be seen as a drug category. The FDA has demanded proof from manufacturers that products in their warehouse have passed border inspection.

No further sale of products containing ma huang will be permitted. Animal products are also being detained, as is shen qu. The FDA is asking for proof of use of animal products prior to 1994 in order to allow their continued use. The American Herbal Products Association is working to provide requested evidence. Mu tong and fang ji have been held in question regarding their aristolochic acid (AA) content. The FDA was unable to locate any quantifiable amount of AA, and has requested that each batch of mu tong or fang ji-containing products be tested in FDA labs five times prior to release for sale. On a positive note, trichosanthes has finally been released.

At this time, we have no word on a meeting date between AAOM and HHS, although a meeting has been promised to AAOM counsel Mark Thoman as it relates to the herbal access project under the new HHS administration. The AAOM suggests that HHS be provided suggestions for a new herb category rather than waiting for FDA to determine one for the profession. The AAOM strongly recommends that vendor category sales are only to professionals not consumers, thus demonstrating responsibility for public safety.

AAOM recommends a definition of "Asian Traditional Medicine" before the FDA attempts to do so. Part of that definition should be that this category of products is reserved strictly for licensed health care providers and that consideration be given, especially in the case of ma huang to the traditional application or use of these herbs. Part of the definition would be the traditional theory and use of these herbs. For example, traditionally, ma huang is never used to assist in weight loss or to increase energy.

CPT Advisory Task Force

Shane Burras and Connie Taylor are co-chairs of the AAOM CPT Task Force. Shane brings over 10 years of experience in the insurance industry, and they are both helping the profession with their commitment, drive and background. The group is currently collecting information on "explanation of benefits" forms from around the country through the AAOM Web site, so that patterns of insurance company practices can be identified and the companies can be educated on our field and rectify any mistaken policies that were developed with regard to new coding.

The following notes are from a presentation by Gene Bruno to the Nevada Oriental Medicine Association:

The codes that designate medical procedures are listed in the Current Procedural Terminology Handbook (CPT). The American Medical Association owns the CPT codes; they are controlled, updated and published yearly by the AMA.

The CPT codes are the property of the AMA and serve as a significant source of income for that organization. The CPT codes are the de facto standard used nationwide and the only HIPAA-compliant code set. HIPAA mandated that there be a consistent code set across the country; regional codes no longer exist. The Centers for Medicare and Medicaid Services (CMS) is the agency responsible for contracting with the AMA and establishing what is essentially a government mandated monopoly.

Why we needed new codes: The codes 99780 & 99781 began in 1998. These old codes were temporary and had no relative value unit (RVU). The AMA was instructed to replace the old codes by the Department of Health and Human Services through their National Committee on Vital Health Statistics. The new codes allow us to continue billing with recognized codes.

History: In 2002, the National Committee on Vital Health Statistics (NCVHS) instructed the AMA to have its CPT Editorial Panel work with representatives of alternative care providers to improve the codes covering complementary and alternative medicine ( CAM) services. Following this directive, the AMA CPT Editorial Panel authorized that a workgroup be created to develop CPT proposals for alternative therapy.

In October 2002, the first meeting of the AMA Acupuncture Work Group was held in Chicago. The group included representatives from the AAOM, the American Academy of Medical Acupuncture and the American Chiropractic Association. Other groups that attended included the American Academy of Physician Assistants, the American Association of Naturopathic Physicians, the American Diabetic Association, the American Institute of Homeopathy, the American Massage Therapy Association, the American Nurses Association, the American Occupational Therapy Association, the American Psychological Association, the Centers for Medicare and Medicaid Services, and the National Center for Complementary and Alternative Medicine.

What the AMA decided: The AMA decided that it would only be issuing one new set of codes for alternative medicine therapy. For various reasons, the AMA decided the acupuncture codes were the codes that they would accept changes to. The new workgroup would be formed to develop new codes for acupuncture. Only the AAOM, AAMA, and ACA were originally invited to participate. At the workgroup's first meeting, it was decided to invite the AOM Alliance to the group to the next meeting. The AMA agreed with this proposal.

Why the AAOM joined the group: The American Association of Oriental Medicine was invited by the AMA to be one of the ranking members of the CPT Acupuncture Work Group. This was the first time any acupuncture organization had been asked to participate and have this amount influence on CPT codes. The AAOM understood the importance of developing these new codes. The AAOM did not create or organize the Work Group or code changes. This was done, as always, by the AMA - but we knew the dangers of not being a part of this process.

Inside the CPT Work Group: All participating groups were restricted by a confidentiality agreement. This meant that absolutely no discussion could be held with anyone outside the boards of each organization. This is why there was no notice of any changes or discussions until the AMA released the final new codes. Originally, the AAOM submitted 15 different codes for implementation. The resulting four codes were all that the Work Group would agree on by consensus. The AMA would only accept code applications that were agreed upon by all members of the Work Group.

The new codes became effective Jan. 1, 2005.

Listing of New Codes

97810 - Acupuncture, one or more needles, without electrical stimulation, initial 15 minutes

97811 - Acupuncture, one or more needles, without electrical stimulation, each additional 15 minutes. With re-insertion.

97813 - Acupuncture, one or more needles, with electrical stimulation, initial 15 minutes.

97814 - Acupuncture, one or more needles, with electrical stimulation, each additional 15 minutes. With re-insertion.

Advantages of New Codes

The new codes allow us to bill for additional work, which the previous codes did not.

In working with the AMA's CPT Committee, we have opened the door to proposing additional codes for other procedures used in acupuncture and Oriental medicine.

The goals and objectives of the CPT Task Force are provided online at www.aaom.org.

Past Presidents and the AAOM Archival Project

The AAOM, as the nation's senior and largest professional acupuncture association, is engaged in the recovery and archiving of significant historical documents. At this stage individuals have come forward with documents that are of historical significance to the association. The executive director's office is collecting and archiving these materials. If anyone has photos, documents or notes that pertain to the early history of the AAOM, please contact the AAOM office.

National Legislation

HR 818, the Federal Acupuncture Coverage Act, would amend the Social Security Act to provide for coverage of qualified acupuncturist services under part B of the Medicare program, and amend Title 5 of the United States Code to provide for coverage of such services under the Federal Employees Health Benefits Program. The AAOM supports Medicare coverage for acupuncture unequivocally.

State Legislation

Michigan: SB 351 was introduced on March 24, 2005. It currently has 14 co-sponsors.

New Mexico: On Sep. 8, 2004, the New Mexico Board of Acupuncture and Oriental Medicine completed a rule hearing that resulted in the creation of a newly approved prescriptive authority formulary and more clearly defined other aspects of the scope of practice.

Illinois: SB 2254 was passed on May 26, 2004 and signed into law on Aug. 23, allowing acupuncturists to treat patients without a physician's referral.

South Carolina: H 3891 was introduced in March 2003, with 36 co-signers. It overrode the veto of the governor and became law on Jan. 13, 2005.

The ACAOM Doctoral Task Force includes representatives from the AAOM, the Acupuncture and Oriental Medicine Alliance, the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM), the Federation of Acupuncture and Oriental Medicine Regulatory Agencies (FAOMRA), the National Federation of TCM Associations (NFTCMA), the World Federation of Chinese Medicine Societies (WFCMS), and ACAOM.

ACAOM is to be commended for the pursuit of due diligence within their purview with regards to the development of doctoral standards and the evaluation of the Oriental medical community's desire for a first professional doctorate. According to an ACAOM survey, 48.5 percent of respondents "support" or "strongly support" a doctorate as a first professional degree, while 49.1 percent "oppose" or "strongly oppose" it. Only 22 people who took the survey said they were neutral on the subject.

The AAOM performed non-structured interviews with the leadership of the southern California Chinese professional associations; one meeting had 600 practitioners in attendance. These practitioners want a first professional doctorate with the title "OMD." It is apparent that these views were not reflected in the ACAOM survey. Our conclusion is that the system of English-language media such as Acupuncture Today and e-mail somehow did not reach this community. The AAOM would urge that the matter be revisited.

The ACAOM Doctoral Task Force is an example of the AOM community coming together in a collegial fashion and effectively working on solutions for our mutual concerns.

Web Site

AAOM has a new image, a new Web site and a new member benefits package at www.aaom.org.

Research

2001-present: prominent collaborative research between the California Oriental medicine profession and UCLA, David Geffen School of Medicine, Department of Family Medicine, entitled "Licensed Acupuncturist Collaborative Study. "

Kuo, Christensen, Gelberg, Rubenstein, and Burke. " Community-Research Collaboration Between Researchers and Acupuncturists. Integrating a Participatory Research Approach in a Statewide Survey of Licensed Acupuncturists in California." Submitted to Ethnicity & Disease; in review, 2005.

AAOM also conducts "futures research" at its annual event through the use of technology first used with the Department of Education and Department of Defense. This technology is used at the President's Roundtable meeting at the AAOM annual conference.

In Closing

It is an honor and a privilege to serve the growing influence and membership of the AAOM. Acupuncture and Oriental medicine will achieve its rightful place in the health care system.

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